New mammogram advice angers some women

Monday

With no family history of breast cancer or other known risk factors, Robyn Sharp didn't worry when Uxbridge's Tri-River Family Health Center called her back for a follow-up exam in 2001.

With no family history of breast cancer or other known risk factors, Robyn Sharp didn't worry when Uxbridge's Tri-River Family Health Center called her back for a follow-up exam in 2001.

But when a doctor showed the Upton mother two suspicious but unidentified spots in her right breast, she predicted the outcome, crying all the way home and calling her husband by cell phone.

As Sharp expected, the spots proved cancerous. A limited first surgery did not remove enough tissue to ensure her health. An expanded second procedure also failed.

Finally, Sharp had a mastectomy, followed by reconstruction. While she lost her original breast, she felt thankful doctors had excised her anxiety, attributing her relative fortune to a routine mammogram just shy of her 40th birthday months earlier.

So the substitute school nurse felt angry when a federal panel last week contradicted common guidelines and advised that screening women in their 40s with mammograms provides more harm than benefit in most cases.

"Even if you save one life, isn't it worth it?" Sharp asked Friday after recounting her story.

The panel, the U.S. Preventive Services Task Force, had previously advised that screenings start at age 40, a recommendation the American Cancer Society and professional associations for oncology and radiology reaffirmed in recent days.

The panel's analysis showed that doctors need to screen 1,904 women in their 40s to save one life, compared to 1,339 women in their 50s.

The panel says it did not consider financial costs. Instead, it decided the frequency of anxiety-causing false alarms and unneeded biopsies left the younger group's screenings unwarranted for those outside high-risk categories.

The advisory group also found no evidence of mammogram benefits for those older than 74, no need for women between the ages of 50 and 74 to get tested annually instead of every other year, and no value in teaching breast self-examination at any age. Those findings also challenge common practice.

Area breast cancer specialists acknowledged the imperfections of mammograms in screening but re-emphasized the importance of the exams and said they are sticking with the previous guidelines. While many area providers' earnings are tied to the volume of mammograms performed, the specialists all cited past patients in their 40s as their motivation.

"You're excluding a certain cohort of women from being screened and being able to save their lives," Newton-Wellesley Hospital's Dr. Alan Semine said, calling the changes "misguided."

Semine, the hospital's chief of breast imaging radiology, said the majority of breast cancer patients don't have a family history, with "high-risk" an imprecisely defined label still being researched and refined.

In addition to questioning the new advice for 40-year-olds, Semine also challenged the finding on self-exams, saying many breast cancers are detected that way.

At Tri-County Breast Surgery inside Milford Regional Medical Center, Dr. Renee Quarterman said breast cancer in patients in their 40s tends to be more aggressive, with women not always flagged beforehand.

"They might just look like they're normal risk," she said.

Marlborough Hospital oncologist Dr. Kathryn Edmiston said the panel's recommendation that 40-year-olds simply check in with their medical provider and craft individual plans only works for those with insurance, access to a doctor and a certain level of knowledge.

"I think that's a very poor public policy," she said.

Are you planning on changing your approach to mammograms because of the recommendations released last week by a federal advisory panel?(opinion)

Edmiston also said the panel just considered mortality, rather than the benefits and value of catching non-fatal cancer early so less of a woman's prime is disrupted. Still, focusing on the group's approach, she described the importance of even just one life.

"All you have to do is sit with her 10-year-old and her 11-year-old to know how devastating that loss of life will be," Edmiston said. Given the aging population and increased life expectancy, she also criticized the panel for casting doubt on the value of mammograms for healthy women older than 74.

The state still requires insurers to cover a baseline mammogram between the ages of 35 and 40 and annual mammograms from age 40 on. Federal Health and Human Services Secretary Kathleen Sebelius said last week that Medicare will also continue to provide similar coverage.

While the nation is looking to rein in medical costs, Semine said there are more appropriate places in the system to save money than mammogram screenings.

"This isn't where we want to make the choices," he said. He decried the possible harm to years of awareness campaigns, feeling that many women are reluctant to come in for mammograms and only do so because that course of action has been drilled in.

"For them to come out and undermine everything that's been accomplished is very disheartening," Semine said of the panel.

At Marlborough Hospital, Edmiston is also responding to the confusion.

"Every patient that now comes into my office asks, 'What am I supposed to do?'" she said.

Sharp's three girls are just 16, 14 and 12, but she knows they will get extra attention when they hit the debated screening mark several decades from now. But Sharp wonders what will happen to other women, strangers with whom she might share a medical bond.

"They have the family history, so they'll be watched," she said of the girls. "But there are other women out there like me. I'm living proof a mammogram saved my life."

MetroWest Daily News writer Michael Morton can be reached at mmorton@cnc.com or 508-626-4338.

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